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Does Your Job Make You Itch and Wheeze?

Occupational contact dermatitis
and asthma are two of the
most common work-related
health issues facing workers worldwide,
according to experts presenting the latest
research at the 2009 Annual Meeting
of the American College of Allergy,
Asthma & Immunology.

“In many countries, occupational
contact dermatitis ranks first among
occupational diseases,” says Donald
Belsito, MD, clinical professor of Dermatology
at the University of Missouri
in Kansas City, MO.

Occupational contact dermatitis involves
an acute or chronic inflammation
of the skin from exposure to chemical,
biological, or physical agents in the
workplace.

“After the skin, the lungs are the
most commonly affected organ in the
workplace,” says Emil J. Bardana Jr., MD,
professor of Medicine in the division
of Allergy-Immunology at Oregon
Health and Science University in
Portland, OR.

Occupational asthma, which is characterized
by inflammation of the airways
with coughing, wheezing, or shortness
of breath, is caused by inhalation of
dust, gases, fumes, vapors, or allergens
in the workplace. “Somewhere between
9 and 15 percent of asthma is probably
work-related,” says Dr. Bardana.

With both contact dermatitis and
asthma, the reaction can be either allergic
or caused by irritation. In the case
of occupational contact dermatitis, 80
percent of cases occur on the hands,
which may become dry, chapped, patchy,
red, and scaly. Most often, the problem
is caused by chronic irritation from water,
soaps, solvents, and greases. It can
take months and even years of exposure
before symptoms occur.

Occupational contact dermatitis
and asthma are two of the
most common work-related
health issues facing workers worldwide.

In the case of occupational asthma,
spray paint is one common trigger, but
anything from chemicals to welding
fumes to soybean dust can be a culprit.

“There are hundreds of potential
triggers of occupational asthma,” says
Paul A. Greenberger, MD, professor of
Medicine in the division of Allergy-
Immunology at Northwestern University,
Feinberg School of Medicine in Chicago,
IL.

Difficult Diagnosis
Diagnosing
occupational asthma is complicated by
the fact that several respiratory conditions
have similar symptoms. Difficulty
also arises in differentiating between
new cases of asthma caused by a work
environment (occupational asthma) and
the worsening of symptoms in workers
who had asthma prior to their job.

“Often times, there is aggravation of
pre-existing asthma that gets blamed on
what’s going on at the job,” says Dr.
Bardana. “Many people who have
asthma don’t even know it.”

Management
With both occupational
asthma and contact dermatitis,
avoiding the irritant or allergen is the
best line of defense.

He adds that most workers with occupational
contact dermatitis who change
jobs should do so for reasons other than
dermatitis. A job change is only necessary
in cases of severe allergy, where
the agent causing the problem cannot
be avoided.

While occupational contact dermatitis
often can be successfully managed
without having to leave a profession,
this is not always the case with occupational
asthma.

“The outcome is related to whether
an allergy or irritant is causing the
asthma, and it depends on how long the
person is exposed,” says Dr. Bardana.
“In general, if an allergy is causing the
asthma, a person can’t go back to the
profession. The quicker they are removed
from the agent they are allergic
to, the better.”

“It may be reasonable to go back
to work if asthma is mild,” Dr. Greenberger
adds. “But there are some
workers that have loss of lung function,
and this is a serious concern.”

In cases where an irritant is causing
asthma, worker education, appropriate
ventilation, or the use of masks might
allow someone to continue the job.

Tough Choices in a Tough Economy
Dr. Greenberger acknowledges the difficult
choices people face when trying
to hold on to a good, paying job while
coping with coughing, wheezing, and
loss of breath; and it is not always clear
whether occupational asthma is the
driving factor.

“Some workers seek compensation
with a belief that everything is caused
by their work environment, even when
it is not,” says Dr. Greenberger. “But
there are also workers with occupational
asthma who refuse to stay off the
job because they need to make a living.
It’s difficult. We want workers to keep
their jobs, but we don’t want them to
lose their lung function.”

Source: American College of Allergy, Asthma & Immunology, www.acaai.org

This article was originally published in Coping® with Allergies & Asthma magazine,
March/April
2010.